Healthcare Provider Details

I. General information

NPI: 1568222933
Provider Name (Legal Business Name): COLLY TETTELBACH RN, MS, MA, CPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLY MCHENRY

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 CARMEL VALLEY RD
CARMEL CA
93923-9556
US

IV. Provider business mailing address

8545 CARMEL VALLEY RD
CARMEL CA
93923-9556
US

V. Phone/Fax

Practice location:
  • Phone: 831-626-4548
  • Fax: 831-625-9827
Mailing address:
  • Phone: 831-626-4548
  • Fax: 831-625-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: